“For every complex problem there is an answer that is clear, simple, and wrong” -H.L. Menken

Keeping “it” simple is important at times. It prevents us from becoming overwhelmed, clarifies concepts, aids in general understanding, and directs the focus towards a single goal. Most importantly, keeping it simple is necessary when communicating new topics or concepts to others. However, the problem occurs when keeping it simple is used a substitute for understanding the complexity.Continue reading “Embracing Complexity: The Mountain Stream Metaphor”

As many physical therapists have probably noticed, there is an increase in the amount of Crossfit athletes showing up in our clinics. This isn’t because it injures everyone. It’s because it’s becoming very popular and people love it.

We see the same thing happen during ski season and marathon season. It’s not necessarily the activity, it’s the increase in participation.

However, that’s not to say that it’s only an increase in participation that leads to a higher incidence of injuries. There are many other variables involved. Some of which can be improved upon to decrease the risk of injury.

In the past 10-20 years there has been a trend towards stabilizing the proximal joint. Everything seems to be going more and more proximally. And this is a good thing! It is providing us with better outcomes and quicker pain free rehabilitation.

If you look at the knee joint you can see the progress. We’ve gone from isolated patella mobs and VMO strengthening to hip strengthening. And now we are going even further up the chain and looking at lumbo-pelvic complex.

The same thing is happening with the shoulder. We’ve gone from isolated thera band ER/IR to scapula stabiliztion. And now we are going even further and looking at the thoracic spine and ribs.

I have been following Erson Religioso, a PT and blogger, for quite some time now. He has repeatedly (no pun intended) discussed the effectiveness of Mechanical Diagnosis & Therapy (The McKenzie Method or MDT). He’s a very knowledgable clinician and runs his social media with integrity. Over the years he has provided a great deal of clinically applicable information and I have seen results in my practice using some of his methods.

Low back pain is one of the most common injuries we see. Traditionally you always hear a lot of information regarding excessive lumbar flexion. And with the amount of information readily available in our society, many patients already know this as well. This has caused some therapists and patients to walk around terrified that the next time they bend over their L5-S1 disc will splatter against the wall behind them. But what about the other direction? What about the potential problems in extension patterns?

The quadruped position is a very important developmental posture. From this posture we learn to crawl and transition to half-kneeling (which then transitions into standing). Through this posture we develop core, shoulder, and hip stability, learn reciprocal UE/LE motion, and begin to control our spine through our weight-bearing extremities. The quadruped position has many details that are often lost or forgotten when training. Mastering these subtleties and progressing within the edge of your ability will lead to a great effect on your stability. Continue reading “Quadruped”

The hip hinge is a basic movement pattern that everyone must have. When people have atrophy of this movement pattern they end up compensating in all sorts of ways (trendenlenberg, dynamic valgus, knee dominant movements, lumbar flexion). This leads to decreased performance and increased risk for injury. Continue reading “Hip Hinge”

Hip strength is extremely important for your musculoskeletal health. The hip muscles are connected from your pelvis to your femur. This connection means they will not only have an influence on your hips, but also effect your back and your knees. In other words, your hips help stabilize and translate forces from your legs to your trunk and vice versa. In addition to this anatomical/biomechanical relationship, our society has a very high prevalence of back and knee pain. So maybe instead of another “core” program or a new squat technique we really just need some hip strengthening. This post will discuss the importance of hip muscles, the effects of hip strength, and how to start strengthening them.

The half-kneeling position is a great way to assess and treat your patients hip and core stability. While it seems like an easy exercise, it has many subtleties that can make or break the position. Having a greater understanding of the half-kneeling position will help ensure that your patient achieves the maximal benefit. Continue reading “Why You Should Use the Half-Kneeling Position”

When prescribing home exercises for my patients I often try to keep it to a minimum of 3 exercises. I understand it’s the last thing people want to do at the end of a long day, especially when they require great effort and concentration. Luckily for those of us that experience pain and discomfort there is an exercise that is easy to perform, doesn’t require a great deal of mental energy, and gravity does all the work for you. Continue reading “Constructive Rest / Passive Alignment / 90-90 Position”

Force Closure

Force closure is a biomechanical myofascial system that helps to produce a “self-locking” mechanism for joints. It occurs when contraction of the muscles/fascia that cross a joint results in increased stability of the joint. This external dynamic myofascial force can increase stability by producing a closed pack articular position (increased congruency), generating segmental stiffness, and increasing compression perpendicular to the joint. Continue reading “Force Coupling for the Lumbo-Pelvic-Hip-Complex”

Low back pain patients are not a homogeneous group, but unfortunately they are often times treated like one. There is an overwhelming amount of causes of pain (disc, ligaments, facet joint capsules, muscle strain/spasm, stress fracture, etc.) and possible diagnosis for low back pain. However, research has shown that the specific “diagnosis” of low back pain rarely correlates with Continue reading “Treatment-Based Classification System for LBP”